Provider Demographics
NPI:1386795383
Name:KENNEY S. ATKINS M.D.,P.C.
Entity type:Organization
Organization Name:KENNEY S. ATKINS M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-964-3345
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MC CAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30555-0669
Mailing Address - Country:US
Mailing Address - Phone:706-964-3345
Mailing Address - Fax:706-964-3347
Practice Address - Street 1:4799 BLUE RIDGE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-0000
Practice Address - Country:US
Practice Address - Phone:706-964-3345
Practice Address - Fax:706-964-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024386208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3013267Medicaid
A97730Medicare UPIN
GAGRP4819Medicare PIN